Modern approach for complex treatment of odontogenic maxillary sinusitis

Abstract

Introduction: Odontogenic maxillary sinusitis is associated with diseases of the maxillary teeth. The close anatomical relationship of these teeth with the floor of the maxillary sinus leads to violation of the integrity of its mucosa and creates prerequisites for the infection to pass into the sinus cavity. Odontogenic maxillary sinusitis is characterized by dental complaints and the typical symptoms of all rhinosinusitis. There is lack of consensus in the literature on the algorithm of behaviour in these cases. Aim: To recommend a contemporary algorythm of management in patients with odontogenic maxillary sinuitis, which is consistent with both the established rules for the treatment of rhinosinusitis and the individual characteristics of each clinical case. Materials and methods: For the period 2001-2021, 157 patients were treated at St. George University Hospital, after extraction of an upper tooth (4-6) or with symptoms of nasal breathing difficulties and unilateral whitish secretion with an unpleasant odour. All of them had a history of dental intervention and CT data for changes in the osteomeatal complex or „foreign bodies“ in the maxillary sinus. Results: All patients were discharged on the third day after admission in improved general condition without complaints. No late postoperative complications were observed. In 8 of the patients with sinuscopy, after the control CT examination, performed a month later, a second intervention was necessary for the extraction of residual fungal material. Conclusion: The treatment of odontogenic maxillary sinusitis involves interdisciplinary approach of otorhinolaryngologists and dental specialists. However, modern understanding of the functioning of the nasal cavities and the development of pathological processes in them help us to build and present an adequate concept for diagnosis and therapeutic behavior.